Resolution of Symptoms and Resumption of Sex After Diagnosis of Nongonococcal Urethritis Among Men Who Have Sex With Men. Issue 10 (October 2019)

• Record Type: Journal Article
• Authors: Chambers, Laura C.; Hughes, James P.; Glick, Sara N.; Morgan, Jennifer L.; Lowens, M. Sylvan; Robinson, Tashina S.; Romano, Sarah S.; Leipertz, Gina L.; Jensen, Jørgen S.; Khosropour, Christine M.; Fredricks, David N.; Golden, Matthew R.; Manhart, Lisa E.
• Is Part Of: Sexually transmitted diseases. Volume 46:Issue 10(2019)
• Publication Date: 2019-10
• Subjects: Sexually transmitted diseases -- Periodicals; Sexual health -- Periodicals; 616.951005
• DOI: 10.1097/OLQ.0000000000001040
• Languages: English
• ISSNs: 0148-5717

Abstract

Abstract : Background: Standard counseling at nongonococcal urethritis (NGU) diagnosis includes advice to abstain from sex for at least 7 days and until symptoms resolve. Methods: From December 2014 to July 2018, we enrolled men who have sex with men and received azithromycin (1 g) for NGU at the Public Health–Seattle and King County STD Clinic. Over 12 weeks of follow-up, participants reported daily urethral symptoms and sexual activity on web-based diaries. Nongonococcal urethritis was defined as urethral symptoms or visible urethral discharge plus 5 or greater polymorphonuclear leukocytes per high-power field. Time of symptom resolution was defined as the first of 5 consecutive asymptomatic days. Results: Of 100 participants with NGU and no Chlamydia trachomatis (CT)/ Mycoplasma genitalium (MG) coinfection, 36 (36%), 22 (22%), and 42 (42%) had CT-NGU, MG-NGU, and non-CT/non-MG NGU, respectively. Among men with MG-NGU, 94% had a macrolide resistance mutation. For all etiologies, median time to symptom resolution after azithromycin was 7 days (95% confidence interval [CI], 5–9); 37% had symptoms lasting longer than 7 days. For men with CT-NGU, MG-NGU, and non-CT/non-MG NGU, median time to symptom resolution was 4 days (95% CI, 2–6; 16% >7 days), undefined days (95% CI, 7 to undefined; 60% >7 days), and 7 days (95% CI, 5–11; 46% >7 days), respectively. Median time to first sexual activity (any type) was 12 days (95% CI, 11–17); it was 16 days (95% CI, 12–18) to first urethral sexual exposure. Twenty-seven percent did not avoid urethral exposure for the recommended period. Conclusions: Counseling at NGU diagnosis should educate patients that symptoms may persist more than 7 days, particularly for non-CT NGU, and emphasize the rationale for the 7-day abstinence period. Abstract : Among men who have sex with men treated with azithromycin for nongonococcal urethritis, 37% had symptoms lasting longer than 7 days, and 27% did not avoid urethral sexual exposure as recommended.